A guide for patients considering orthodontics and jaw surgery (Orthognathic Treatment)

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1 A guide for patients considering orthodontics and jaw surgery (Orthognathic Treatment)

2 Why would I benefit from orthognathic treatment? This type of treatment can correct your occlusion (bite) and change your facial profile. In some cases treatment is planned to improve your bite, with minimal change to your facial appearance, whilst in other cases, there will be more noticeable change to your facial appearance (for example if you have a prominent lower jaw, or a small setback lower jaw). Is there an alternative to this treatment? In some cases there may be an alternative treatment. You will need to ask the team, if this is possible in your case. The team will explain the advantages and disadvantages of all options. What will treatment involve? Treatment is carried out over a period of 2 1 /2-3 years, starting with orthodontic treatment to reposition your teeth with fixed appliances (traintrack braces). Approximately two thirds of the way through treatment you will be ready for the jaw surgery. Following the surgery, patients generally continue with the orthodontic treatment with fixed appliances for 6-9 months. When the fixed appliances are removed you will be provided with removable retainers which will help maintain your teeth in the new position. Some patients will also require a retainer fixed to their teeth. The orthodontist will advise you how much to wear the retainers. In most cases for the first year you will start wearing your retainers all the time (day and night) and will then be advised to gradually reduce the amount you wear your retainers. After a year of retainer wear, you will be advised to wear the retainers a few nights a week indefinitely. 2

3 Your progress will be reviewed regularly for five years after your surgery. What does the jaw surgery involve? Jaw surgery may involve surgery to your upper jaw (maxilla) or the lower jaw (mandible) or a combination of both depending on your concerns and individual assessment by the team. The surgery is carried out from inside your mouth so there are no visible scars on your face. For some types of surgery there may be a tiny cut made at the angle of the jaw. However, this is virtually invisible a few weeks after the surgery. During jaw surgery your jaws are repositioned and held in their new position by small screws and plates beneath the gum, which are generally left there indefinitely. You will not usually have your jaws wired together. However, you will be required to wear orthodontic elastics, whilst your bite settles following the surgery. Risks associated with jaw surgery include Lip numbness: This is normal, immediately after the surgery. The upper lip recovers quickly. However the lower lip is much more variable and may take time to recover. Some patients report areas of permanent numbness which does not affect the appearance of the lip or its function. Patients reporting areas of permanent altered sensation find that this is something they get used to. Infection of the plates beneath the gum: In a small number of cases plates may become infected. If this is the case they are removed. The chance of this occurring is greater if you smoke cigarettes. Patients are advised to stop smoking, if they are planning to undergo jaw surgery. 3

4 Re-adjustment of the bite: Occasionally the team may suggest that you would benefit from a second operation to adjust the bite. This is generally rare, and the benefits of this would be discussed with you. Relapse after surgery: This is unusual. However, there may be a relapse in the position of the jaws or the teeth. When this occurs it does not usually require a further operation as the changes tend not to be significant. How long will I be in hospital for the surgery and what is the recovery period like? Most patients stay in hospital for one night, and need between 2 and 4 weeks off work/ college/university. The speed of recovery varies from patient to patient. You will probably be swollen after the operation with the swelling of the face at its worst hours after the operation. This usually improves over the following 2 to 3 weeks with your final facial appearance being apparent over a few months. The amount of change in your facial appearance will depend on whether your surgery was planned to have minimal or a more noticeable effect on your appearance. It is not unusual for patients to feel down after the surgery. It can take time for patients to get use to their new bite and facial appearance. We can arrange for you to have the appropriate psychological support if required. Care after the surgery We encourage you to start drinking and eating soft foods after the surgery. Most patients lose some weight after surgery, so it is important you make an effort to keep up your calories. 4

5 Your mouth opening will be reduced after surgery owing to swelling, so you should eat soft foods (soups, smoothies, yogurt etc.) Over the next few weeks you should return to a normal diet, avoiding hard foods for up to six weeks whilst the jaw bones heal. Tooth brushing is very important throughout treatment but especially so after surgery. You are advised to use a soft toothbrush for the first few weeks after surgery. We will give more detailed practical advice before surgery and also before you leave the hospital to go home. We usually review patients weekly after the surgery for 2 to 3 weeks. Further questions We will be able to answer any questions at your next clinic appointment. You may find it helpful to bring a family member with you. Should you have any further questions or concerns, please do not hesitate to contact the orthodontic department on: QVH Orthodontic Department: or For further information and patient experiences please visit 5

6 6 Patient progress through treatment: Case 1

7 Pre-treatment Pre-jaw surgery End of treatment This patient has had lower jaw surgery to bring the lower jaw forwards to correct the bite and improve the lower jaw and chin prominence. 7

8 8 Patient progress through treatment: Case 2

9 Pre-treatment Pre-jaw surgery End of treatment This patient has had upper and lower jaw surgery with correction of her lower jaw asymmetry, to correct the bite and alter the facial balance. 9

10 10 Patient progress through treatment: Case 3

11 Pre-treatment Post Surgical Assisted Expansion (SARPE) Pre-jaw surgery End of treatment This patient has had surgically assisted rapid expansion to widen the upper jaw, followed by upper and lower jaw surgery, to correct the bite with some change in her facial profile / balance. 11

12 12 Patient progress through treatment: Case 4

13 Pre-treatment Pre-jaw surgery End of treatment This patient has had upper and lower jaw surgery to correct her facial asymmetry. 13

14 Queen Victoria Hospital NHS Foundation Trust is a specialist hospital providing orthognathic (jaw surgery) for people across the South East of England. Our surgeons carry out jaw surgery for patients having the orthodontic part of their jaw surgery treatment at a number of hospitals in Kent, Surrey, and Sussex as well as at Queen Victoria Hospital in East Grinstead. Please refer to your appointment letter for contact details. Please ask if you would like this leaflet in larger print or an alternative format. Orthodontics Department Issue 3 Ref: no Approved by the Patient Information Group Print February 2017 Review February 2020 Copyright QVH NHS Foundation Trust